Provider Demographics
NPI:1053771287
Name:LA FAMILIA COUNSELING SERVICES
Entity type:Organization
Organization Name:LA FAMILIA COUNSELING SERVICES
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:DANIELA
Authorized Official - Middle Name:FRANCISCA
Authorized Official - Last Name:PETERSON
Authorized Official - Suffix:
Authorized Official - Credentials:LPC
Authorized Official - Phone:307-413-6528
Mailing Address - Street 1:825 HI COUNTRY DR
Mailing Address - Street 2:
Mailing Address - City:JACKSON
Mailing Address - State:WY
Mailing Address - Zip Code:83001-9442
Mailing Address - Country:US
Mailing Address - Phone:307-413-6528
Mailing Address - Fax:
Practice Address - Street 1:140 E BROADWAY AVE STE B-13
Practice Address - Street 2:
Practice Address - City:JACKSON
Practice Address - State:WY
Practice Address - Zip Code:83001-8632
Practice Address - Country:US
Practice Address - Phone:307-413-6528
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-03-01
Last Update Date:2016-03-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WY1071101YP2500X
WY136103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessionalGroup - Single Specialty
No103T00000XBehavioral Health & Social Service ProvidersPsychologistGroup - Single Specialty